摘要
目的探讨胸段食管鳞癌R0切除术后p T3~4N0或p T1~4N1~3患者接受辅助治疗的临床疗效。方法回顾性分析2009年1月至2013年12月间收治的胸段食管鳞癌R0切除术后p T3~4N0或p T1~4N1~3患者接受术后辅助治疗的情况,共入组患者262例,根据术后辅助治疗情况分为单纯手术组（n=111）、辅助化疗组（n=91）和辅助放疗组（n=60）。采用Kaplan-Meier法计算生存率,Cox多因素回归法分析影响患者预后的独立因素。结果辅助放疗组和辅助化疗组患者的中位无病生存期（DFS）均优于单纯手术组（均P〈0.05）,但辅助放疗组与辅助化疗组间差异无统计学意义（P=0.664）。辅助放疗组和辅助化疗组患者的中位总生存期（OS）均优于单纯手术,差异均有统计学意义（均P〈0.05）,但辅助放疗组和辅助化疗组间差异无统计学意义（P=0.944）。对于p T3~4N0患者,辅助化疗组OS高于单纯手术组（P=0.042）;对于p T1~4N1~3患者,辅助放疗组及辅助化疗组OS均优于单纯手术组（均P〈0.05）,但辅助放疗组与辅助化疗组差异无统计学意义（P=0.310）。而对于局部浸润较深且淋巴结转移的p T3~4N0患者,辅助放疗组和辅助化疗组OS均优于单纯手术组（均P〈0.05）,且辅助放疗组也优于辅助化疗组（P=0.011）。Cox多因素回归分析显示,肿瘤部位、肿瘤浸润深度（p T）、病理淋巴结转移个数（p N）、肿瘤分析程度、术后治疗均为影响患者生存的独立预后因素（均P〈0.05）。结论对于p T1~4N1~3患者,术后辅助化疗或辅助放疗均可显著改善DFS和OS,其中p T3~4N1~3患者,辅助放疗获益更大。
Objective To investigate the efficacy of adjuvant therapy for p T3 ~ 4N0 and p T1 ~ 4N1 ~ 3 esophageal squamous cell carcinoma（ ESCC） patients after esophagectomy. Methods From Jannuary 2009 to December 2013 in 307 Hospital of PLA,262 p T3 ~ 4N0 and p T1 ~ 4N1 ~ 3 ESCC patients who had underwent curative esophagectomy were enrolled in the study. They were divided into surgery group（ n = 111）,adjuvant chemotherapy group（ n = 91） and adjuvant radiotherapy group（ n = 60）. KaplanMeier method was used to analyze the survival rate. Cox proportional model was used for analyzing prognostic factors. Results Of these patients,111 rceived surgery alone（ S group）,91 underwent adjuvant chemotherapy（ mainly taxane-based） following surgery（ SC group） and 60 underwent adjuvant radiotherapy（ SR group）. The disease-free survival（ DFS） rates of SC group and SR group were significantly higher than that of S group（ all P〈0. 05）,but no significant difference was found between SC group and SR group（ P =0. 664）. In patients with p T1 ~ 4N1 ~ 3,overall survival（ OS） of SC group and SR group were significantly higher than that of S group（ all P〈0. 05）,but no significant difference was found between SC group and SR group（ P = 0. 310）. But in patients with p T3 ~ 4N1 ~ 3,OS of SC group and SR group were significantly higher than that of S group（ P = 0. 037,P〈0. 01）,and SR group was significantly higher than that of SC group（ P = 0. 011）. Multivariate analysis revealed that tumor location,depth of tumor invasion（ p T） 、numbers of lymph node metastasic（ p N） and adjuvant therapy were independent prognostic factors. Conclusions Adjuvant chemotherapy and adjuvant radiotherapy could improve the DFS and OS of patients with p T1 ~ 4N1 ~ 3. Patients with p T3 ~ 4N1 ~ 3 could benefit more from adjuvant radiotherapy.
出处
《中国肿瘤临床与康复》
2015年第10期1165-1170,共6页
Chinese Journal of Clinical Oncology and Rehabilitation
关键词
食管肿瘤
癌
鳞状细胞
外科手术
辅助治疗
Esophageal neoplasms
Carcinoma
squamous cell
Surgery
Adjuvant therapy
